Classification of Periprosthetic Tibial Fractures

Abstract

Contrary to the extensive literature detailing periprosthetic femur fractures associated with total knee arthroplasty, there is little information available regarding periprosthetic tibial fractures. Between 1970 and 1992, there were 32 cases of tibial fractures located below a total knee arthroplasty that were mentioned in nine different reports.1 The largest report described 15 stress fractures of the tibia following Geomedic and Polycentric knee arthroplasty.2 This fracture pattern was associated with axial malalignment and improper component orientation and all knees eventually required revision arthroplasty. Since 1992, several authors have reported tibial fractures in association with a tibial tubercle osteotomy.4,5 Two different fracture patterns were described in these reports, which included five tibial shaft fractures and two minimally displaced tibial tubercle fractures. We recently reviewed 102 periprosthetic tibial fractures that were diagnosed and treated at our clinic between 1970 and 1995 and concluded that classification and treatment of these fractures could be based on three primary factors: (1) the anatomic location of the fracture, (2) the timing of the fracture’s being in either the intraoperative or postoperative periods, and (3) the radiographic determination of prosthesis fixation as being well-fixed or loose at the time of the fracture.3 Accordingly, we suggest the following fracture classification and treatment recommendations for periprosthetic tibial fractures associated with total knee arthroplasty.